Nevin Manimala

Int Urogynecol J. 2026 May 7. doi: 10.1007/s00192-026-06536-4. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating disorder of unclear etiology that impairs quality of life; physically, emotionally, and sexually. Up till now, no standard effective therapy has existed. Phosphodiesterase-5 inhibitors are vasodilatory and anti-inflammatory. We studied the efficacy and safety of tadalafil, amitriptyline, and their combination in female IC/BPS patients.

METHODS: In this study, 132 female patients were randomized into three groups. Assessments were performed at baseline and at 4, 8, and 12 weeks using voiding diary, uroflowmetry, the visual analog scale (VAS), the Interstitial Cystitis Symptom Index (ICSI), and the Interstitial Cystitis Problem Index (ICPI). Global Response Assessment (GRA) and correlations between VAS and voided volume were analyzed at the end. Statistical analysis was performed using the Kruskal-Wallis test.

RESULTS: Tadalafil and combination improved daytime voids more than amitriptyline (tadalafil vs amitriptyline p = 0.0005, amitriptyline vs combination p < 0.0001, tadalafil vs combination p = 0.0009). Night-time voids improved notably in tadalafil and combination vs amitriptyline (p < 0.0001). Maximum urinary flow rate (Qmax) increased in combination and tadalafil vs amitriptyline (p = 0.0004) and (p = 0.0294) respectively. Voided volume was higher in combination vs amitriptyline (p = 0.0041). ICSI, ICPI, and VAS scores decreased in all groups (p < 0.0001). Ninety-two patients achieved a GRA score of 7. VAS correlated with voided volume in the tadalafil group (r = -0.60). Amenorrhea was the most bothering adverse event among the patients in the tadalafil group.

CONCLUSIONS: Tadalafil, alone or combined with low-dose amitriptyline, is a safe and effective treatment for female IC/BPS. The combination had comparable or superior efficacy to tadalafil using a lower amitriptyline dose while reducing adverse events.

PMID:42096062 | DOI:10.1007/s00192-026-06536-4

Int Urogynecol J. 2026 May 7. doi: 10.1007/s00192-026-06656-x. Online ahead of print.

ABSTRACT

INTRODUCTION: The efficacy of pelvic floor muscle training (PFMT) in preventing and treating postpartum urinary incontinence remains inconclusive. This systematic review aims to evaluate the efficacy of pelvic floor muscle training (PFMT) in treating postpartum urinary incontinence (PPUI).

METHOD: We systematically searched Embase, PubMed, and Cochrane Library for randomized controlled trials (RCT) investigating PFMT for PPUI. Studies published before October 2024 were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Cochrane Risk of Bias Tool (ROB 2.0). Meta-analyses were performed using random-effects models, with effect sizes reported as risk ratios (RR) or standardized mean differences (SMD) with 95% confidence intervals (CI).

RESULTS: A total of 19 RCTs were included in the analysis. Statistically significant improvements were observed in pelvic floor muscle strength (SMD 0.61, 95% CI [0.10, 1.12], P = 0.02) and endurance (SMD 0.68, 95% CI [0.06, 1.30], P = 0.03). However, no significant differences were found in quality of life (SMD -0.46, 95% CI [-1.18, 0.27], P = 0.22) or urinary incontinence incidence (RR 0.87, 95% CI [0.73, 1.04], P = 0.12). The subgroup analysis demonstrated that supervised PFMT interventions lasting more than 8 weeks were the most effective approach for improving pelvic floor muscle strength.

CONCLUSION: Pelvic floor muscle training (PFMT) demonstrates significant efficacy in improving pelvic floor muscle function (strength and endurance) in postpartum women with urinary incontinence (UI), supporting its physiological mechanism of action. However, owing to limitations in the available data and substantial heterogeneity across studies, the direct impact of PFMT on symptom resolution-specifically UI incidence and quality of life-remains less certain and should be interpreted with caution.

PMID:42096061 | DOI:10.1007/s00192-026-06656-x

Clin Oral Investig. 2026 May 7;30(6):220. doi: 10.1007/s00784-026-06899-4.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the clinical outcomes of gingival recession Type 1 (RT1) treatment using a coronally advanced flap (CAF) alone and in combination with L-PRF at 6 months.

MATERIALS AND METHODS: A total of 70 RT1 from 19 patients were included. Participants were randomly assigned to the test group (TG, CAF + L-PRF, n = 42) and the control group (CG) (CAF alone, n = 28). Clinical parameters were assessed at baseline and at 6 months: the primary outcomes were percentage of root coverage (%RC) and complete root coverage (CRC); and the secondary outcomes included mean root coverage (MRC), changes in gingival thickness (GT) and volumetric tissue gain, recession area reduction, analgesic consumption, healing quality (the Inflammatory Proliferative Remodeling [IPR] score), and patient-reported outcome measures (PROMs). Statistical analyses were performed to determine differences between groups; a random-intercept mixed-effects model was used for all site-level outcomes.

RESULTS: At six months, %RC was 89.30% ± 20.33% (TG) and 81.60% ± 27.93% (CG) (p > 0.05). For the TG and CG, respectively, %CRC was 73.81% and 57.14%; the mean GT gain was 0.16 ± 0.10 mm and 0.11 ± 0.10 mm (p = 0.08); the mean volume gain was 1.13 ± 1.25 mm³ and 0.86 ± 0.84 mm³ (p = 0.32); the mean number of pills taken was 1.67 ± 0.98 and 2.25 ± 1.02 (p = 0.04); the esthetic satisfaction was 95% ± 5% and 90% ± 7% (p = 0.31); willingness to undergo the procedure again: 93% ± 4% and 88% ± 6% (p = 0.22); sensitivity reduction: 85% ± 6% and 80% ± 8% (p = 0.19). There was no statistically significant difference in healing quality and PROMs.

CONCLUSION: Both CAF alone and CAF combined with L-PRF yielded comparable clinical and volumetric outcomes in RT1 treatments. No statistically significant advantages were observed with the adjunctive use of L-PRF.

CLINICAL RELEVANCE: Because CAF alone achieves high predictability for RT1 defects, the routine adjunctive use of L-PRF provides limited additional clinical benefits.

PMID:42096052 | DOI:10.1007/s00784-026-06899-4

Anat Sci Int. 2026 May 7. doi: 10.1007/s12565-026-00934-w. Online ahead of print.

ABSTRACT

Sex determination from skeletal remains presents significant challenges, particularly when bones are damaged or incomplete. In such cases, histomorphological analysis of fragmented bone pieces becomes essential. The medial clavicle is recognized as a valuable anatomical marker in forensic and anthropological research due to its pronounced sex-related morphological variations. This study aimed to develop a deep learning-based method for sex determination using histological images of the medial clavicle in Thai population, and to evaluate its performance with both validation and blind test sets utilizing the GoogLeNet convolutional neural network architecture. A total of 100 pairs of clavicles were included, with 70 cases (35 males,35 females) assigned to the training group and 30 (15 males,15 females) to the test group. Histological images underwent pre-processing and were standardized in size before being input into the training model. Validation accuracy was assessed using MATLAB, while descriptive statistics for the test set were calculated with SPSS software. GoogLeNet demonstrated superior performance, achieving a validation accuracy of 96.43% and a blind test accuracy of 90%. These results highlight the potential of a deep learning approach using 2D histological images of the medial clavicle as a straightforward and effective tool for sex determination in forensic anthropology, offering a high degree of accuracy. This method paves the way for rapid, objective, and accessible sex identification, even from fragmented human remains, and demonstrates promise for broader applications in the forensic and anthropological sciences.

PMID:42096030 | DOI:10.1007/s12565-026-00934-w

Dan Med J. 2026 Apr 17;73(5):A05250419. doi: 10.61409/A05250419.

ABSTRACT

INTRODUCTION: Neovascular age-related macular degeneration (nAMD) affects approximately 8% of the global population. While socioeconomic and geographical disparities have been increasingly studied in Denmark, geographical disparity in best corrected visual acuity (BCVA) at the time of diagnosis in nAMD remains understudied. This study aimed to investigate possible geographical disparity in BCVA at the time of diagnosis in nAMD patients in Region Zealand, Denmark.

METHODS: This was a retrospective study using data from the database “Bedre Oftalmologi for Brugere” from 2011 to 2021. BCVA was extracted for patients at the time of diagnosis with nAMD. Patients were grouped geographically by postal code and municipality. Data were analysed using the Kruskal-Wallis test to investigate geographical disparity and stratified by sex.

RESULTS: A total of 4,266 eyes with nAMD were included. Variations in BCVA at the time of nAMD diagnosis were found between geographical regions in Region Zealand at postal code level and at municipality level. Furthermore, we found a disparity between municipalities among males and females. However, no statistically significant disparity between postal codes was found among males or females.

CONCLUSIONS: There was a significant geographical disparity in BCVA at the time of diagnosis in nAMD patients, inviting further investigation to determine the extent and roots of this disparity.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.

PMID:42095312 | DOI:10.61409/A05250419

Palliat Support Care. 2026 May 7;24:e135. doi: 10.1017/S1478951526102624.

ABSTRACT

OBJECTIVES: Patients hospitalized with a life-limiting illness, along with their loved ones, frequently experience anxiety, stress, and pain. Legacy building through storytelling and music may alleviate emotional strain and provide comfort. Musical Rounds is a novel music medicine program designed to reduce distress and support legacy building for adult patients receiving palliative care and their loved ones.

METHODS: This multisite, mixed-methods, pre-post feasibility study was conducted across 3 hospitals in California, USA. Participants engaged in live bedside recording sessions in which personal stories were shared with real-time musical improvisation provided by a clinician-musician. Afterward, participants received a personalized edited recording combining voice and improvised music. Pain, stress, anxiety, and comfort were assessed before and after each session using a 0-10 numeric rating scale. Perceived mood changes were assessed through directed qualitative content analysis.

RESULTS: We invited 100 adult patients hospitalized with a life-limiting illness and their loved ones to participate. If patients were unable to respond, loved ones participated on their behalf. Patients (n = 79) demonstrated statistically significant within-group differences between pre- and post-session assessments, including lower pain (-1.58, p < .001), stress (-2.89, p < .001), and anxiety (-2.73, p < .001), and higher comfort (+1.61, p < .001). Loved ones (n = 42) reported lower stress (-3.14, p < .001) and anxiety (-2.86, p < .001), and higher comfort (+1.83, p = .004). Directed content analysis indicated perceived mood improvement in 59% (47/80) of patients and 68% (30/44) of loved ones.

SIGNIFICANCE OF RESULTS: Musical Rounds, a personalized music and storytelling session for hospitalized patients with life-limiting illness and their loved ones, was associated with lower self-reported stress, pain (patients only), and anxiety, and higher comfort and perceived mood across 3 hospitals. Findings demonstrate the feasibility and suggest potential benefits of music medicine-supported legacy building in palliative care. Controlled studies with independent assessors are needed to further evaluate efficacy.

PMID:42095303 | DOI:10.1017/S1478951526102624

Eur Heart J Cardiovasc Pharmacother. 2026 May 7:pvag032. doi: 10.1093/ehjcvp/pvag032. Online ahead of print.

ABSTRACT

AIMS: The absence of stent implantation when using drug-coated balloons (DCB) may decrease the required duration of dual antiplatelet therapy (DAPT). In the light of this, this study aimed to evaluate outcomes for patients with acute coronary syndromes treated with abbreviated versus standard DAPT after DCB-only PCI.

METHODS AND RESULTS: Patients enrolled in the SWEDEHEART registry between June 2013 and February 2022, treated exclusively with DCBs for ACS, were included. Only patients discharged with ticagrelor as P2Y12-inhibition were included. Patients were categorized by intended DAPT duration at discharge. The primary outcome was net adverse clinical events (NACE) at one year from discharge date, defined as the first occurrence of all-cause death, stroke, myocardial infarction, or major bleeding. The primary analysis used inverse-probability-of-treatment-weighted (IPTW) Cox regression. Among 1,128 patients (141 abbreviated DAPT, 986 standard DAPT), NACE occurred in 25 patients (crude 17.7%; weighted 17.8%) in the abbreviated-DAPT arm and 133 patients (crude 13.5%; weighted 13.8%) in the standard-DAPT arm, corresponding to a weighted hazard ratio of 1.29 (95% CI 0.81-2.03; p=0.28). Results were consistent across pre-specified sensitivity analyses. Due to the small sample size, variance was generally high.

CONCLUSION: In this nationwide registry-based analysis, abbreviated DAPT following DCB-only PCI in ACS was not associated with a statistically significant difference in NACE. However, the confidence intervals were wide and did not exclude clinically meaningful harm. The findings should be regarded as hypothesis-generating and indicate the need for more comprehensive evidence before abbreviated DAPT is routinely adopted in this setting.

PMID:42095276 | DOI:10.1093/ehjcvp/pvag032

ACR Open Rheumatol. 2026 May;8(5):e90051. doi: 10.1002/acr2.90051.

ABSTRACT

OBJECTIVE: Premature mortality burden is an important component of disease burden and can help guide health care and research priorities. However, relying solely on mortality rates may underestimate lupus mortality burden because a substantial proportion of deaths occur at younger ages. Years of potential life lost (YPLL) captures premature mortality by applying a predefined age threshold. We estimated the YPLL from lupus in US women relative to leading causes of death and other autoimmune diseases.

METHODS: Using the US population-based national Multiple Cause-of-Death database, we obtained death counts for 28 diseases, including lupus, the Centers for Disease Control and Prevention’s 15 leading causes of death, and 12 additional autoimmune diseases. We calculated YPLL before age 75 years by summing 75 minus age at death for deaths occurring before age 75. Official cause-of-death rankings were obtained from the Web-based Injury Statistics Query and Reporting System (WISQARS). Sensitivity analyses were repeated in female decedents during 2018 to 2024.

RESULTS: From 2000 to 2015, 304.2 thousand years were lost to lupus in US women aged 15 to 44 years. Lupus-associated YPLL ranked 14th in women aged 15 to 44 years and 9th in women aged 15 to 24, exceeding diabetes mellitus, HIV disease, septicemia, chronic lower respiratory disease, anemias, nephritis, and cerebrovascular disease. Among autoimmune diseases, lupus YPLL ranked first in women aged 15 to 24 years and second in women aged 15 to 44 years.

CONCLUSION: Lupus is a major contributor to premature mortality in young women. Quantifying premature mortality burden through YPLL provides a complementary public health perspective and may inform prioritization of research and public health initiatives.

PMID:42095257 | DOI:10.1002/acr2.90051

Int J Nurs Stud Adv. 2026 Apr 29;10:100544. doi: 10.1016/j.ijnsa.2026.100544. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Scarce or insufficient nursing resources are an important reason that nurses have to ration necessary nursing tasks implicitly. Implicit rationing of nursing care is associated with negative patient and nurse outcomes, such as poor patient safety and low job satisfaction. The frequency at which nursing students implicitly ration nursing tasks during their clinical placements and the prioritisation strategies they use remain unclear.

AIM: To describe the levels of implicit rationing of nursing care, prioritisation strategies used by Swiss and Turkish nursing students during their clinical placements, and characteristics of their nursing work environment.

METHODS: This descriptive, cross-sectional observational study included 506 Swiss and 750 Turkish eligible students from four universities, with a final sample size of 81 and 205 students, respectively. Implicit rationing of nursing care was measured using the Basel Extent of Rationing of Nursing Care-Revised (BERNCA-R) version on a scale of 0 (‘never’) to 3 (‘often’). The prioritisation strategies were assessed with a single item. In addition, data on workplace characteristics and demographics were collected. Data were analysed using descriptive statistical methods.

RESULTS: Among the 23 BERNCA-R items compared in this study, the reported rationing levels in the Swiss sample ranged from 0.52 (‘change of wound dressings’) to 1.83 (’emotional and psychological support’), and in the Turkish sample, the levels ranged from 0.74 (‘necessary disinfection measures’) to 1.63 (‘sponge bath’). The Swiss students prioritised nursing tasks primarily based on ‘their necessity’ and/or ‘associated consequences for patient safety’, whereas the Turkish students prioritised them mainly based on ‘their necessity’. The Swiss students rated the staffing and resource adequacy, overall quality of the work environment, quality of care, and patient safety at their most recent clinical placement workplace slightly higher than that rated by the Turkish students.

CONCLUSIONS: This study demonstrates the importance of teaching resource scarcity management and care prioritisation strategies to reduce students’ implicit care rationing during clinical placements.

TWEETABLE ABSTRACT: Implicit rationing and associated factors from the perspective of nursing students: a cross-sectional and cross-cultural comparative observational study, from Switzerland and Türkiye.

PMID:42095233 | PMC:PMC13141541 | DOI:10.1016/j.ijnsa.2026.100544

Front Nutr. 2026 Apr 21;13:1807288. doi: 10.3389/fnut.2026.1807288. eCollection 2026.

ABSTRACT

BACKGROUND: The triglyceride-cholesterol-body weight index (TCBI) has been proposed as a composite indicator of nutritional-metabolic status, yet evidence regarding its association with incident CVD in general aging populations and across different modeling strategies remains limited.

METHODS: We analyzed harmonized data from the China Health and Retirement Longitudinal Study (CHARLS: 2011-2018) and the English Longitudinal Study of Aging (ELSA: 2002-2018). Community-dwelling adults aged 45 years and older and free of CVD at baseline were included. Baseline TCBI was calculated as triglycerides × total cholesterol × body weight /1,000 and primarily analyzed as a log-transformed continuous variable. Incident CVD was defined as physician-diagnosed heart disease or stroke during follow-up. Cox proportional hazards models, restricted cubic spline analyses, and prespecified subgroup analyses were conducted separately in each cohort.

RESULTS: A total of 6,013 participants (CHARLS: 3,741; ELSA: 2,272) were included. In the fully adjusted model, higher baseline TCBI was significantly associated with incident CVD in both cohorts (CHARLS: HR = 1.216, 95% CI (1.092, 1.352); P < 0.001; ELSA: HR = 1.195, 95% CI (1.022, 1.396); P = 0.025) when modeled as a continuous variable. Quartile-based analyses were broadly consistent, although the pattern was not entirely monotonic, particularly in ELSA. Restricted cubic spline analyses showed a significant overall association without evidence of non-linearity in CHARLS, whereas neither the overall nor the non-linear association was statistically significant in ELSA. The results remained robust in lag analyses. However, the incremental predictive value of TCBI beyond conventional risk factors was minimal, with no significant improvement in discrimination or reclassification in either cohort.

CONCLUSIONS: Higher baseline TCBI was associated with incident CVD in two large aging cohorts, especially when modeled as a continuous exposure. However, its incremental predictive value beyond conventional cardiovascular risk factors was minimal. TCBI may therefore serve as a complementary metabolic and nutritional indicator rather than a stand-alone predictive tool.

PMID:42095219 | PMC:PMC13138991 | DOI:10.3389/fnut.2026.1807288